Should I take probiotics?

"I know that the concept of "friendly" bacteria is attractive, and it is still accepted by the medical community in general.

However, in the last few years scientists have grown to understand that it is the innate immune system which is active in the GI tract, and not adaptive immunity. Because of this, the whole concept of "friendly" bacteria has to be re-examined, and much of it scrapped.

Probiotics are not very 'friendly' at all. The MP will kill the bacteria in the GI tract which have accumulated from the food you eat, and the fluids you drink. You need them to do that in order to recover from chronic disease." ...Trevor.. Mar08

"The science tells me that palliation from probiotics probably comes from overloading the innate immune system in the GI tract.

Normal probiotics force the innate immune system to challenge them in the GI tract. Inflammatory cytokines are produced, hence the immunopathology. The cytokines will also cause a migration of monocytes to the GI tract, the site of immune challenge. Thus the monocytes will be unable to attack pathogens in the liver, kidney, or even pancreas, as they are being sidelined to the GI tract. More immunopathology, but perhaps a little easier to tolerate in the Gi tract than in the kidney, liver or pancreas.

As for disbacteriosis (the absence of good bacteria in the gut), many of the MP folks are taking intestinal flora capsules or tablets (probiotics). I never bothered with that. The intestines become so infected with e-coli, and other L-form species, that flora become a secondary issue to intestinal mis-function, IMO. The pathogens are the key factor, as they inhibit peristalsis, and mess things up in a host of other ways.

I am personally not convinced that probiotics are helpful to the healing process, as their function appears to be via stimulation of the innate immune system in the gut.

So if they work for you, keep using them, but if you are just following what you read in, eg, 'Readers Digest' I would suggest re-evaluating what they are really doing for you

As we begin to understand more about the way the body works, one must question whether probiotics might just be masking the underlying problem. I have not observed any negative effects. They are OK to continue if they seem to be giving some relief from the GI symptoms, as GI mischief is a real nuisance.

Here is a paper by Dave Relman which goes into some other aspects of this issue.

MP folk who are taking multiple antibiotics for year after year, certainly enough abx to kill off any existing flora, still have a functioning GI tract without taking probiotics"

..Trevor..

May 07 Dr. Marshall writes: I will get my head cut off here by somebody but I have seen no convincing evidence that probiotics have any essential function to play in the GI tract.

I think the linkage drawn between probiotics and fungal infection is incorrect, and I think it arose because medicine did not understand how active the innate immune system is in GI function. Stimulating that innate immune system with pathogens (probiotic 'flora') might well increase the production of 'immune system stuff' which would reduce the likelihood of a secondary fungal infection.

Once the MP has gotten your immune system back into balance I would doubt that probiotics would have any useful function to play. Here is some further reading...

http://www.pnas.org/cgi/content/full/103/3/732

June 07: "I am not convinced that any of the microbiota are essential for health. I am still looking for evidence of benefit, I don't see it. The bugs help us grow old, they help us get ill. Maybe there are offsetting positives. I just haven't found any yet

Folk who think they are healthy (but remember everybody is carrying some sort of mix of microbiota) might feel some benefit from using probiotics, but since all they are doing is making their innate immune system work a little harder, I am not sure there is any long-term benefit to be gained from probiotics."

..Trevor..

When you consider the ramifications of autonomic nervous system inflammation, you can see that it may not be as simple as what you are eating or inflammation in the tissues of the GI tract.

July 30, 2007: Would we suffer vitamin deficiencies if all gut bacteria were elminated? We almost have enough data to answer this question, but not quite definitively. My current gut feeling is no- the bacteria may be helpful in several ways but the human body will adapt to their absence. We will have a full answer in another year or two.

The answer will come when more folks on the MP get to full recovery (their own innate immune systems working again) yet they are still taking prophylactic antibiotics (which no longer produce immunopathology). These folks will have no, or very little, gut flora. The few of us in that situation right now are not needing supplements, so it seems the body has adjusted.

..Trevor..

Sept 07 I personally had a very diseased gut until about year 5 into the MP. Bloating, pain, and a host of other symptoms were a constant nuisance. I never found any probiotic to be any use in reducing those symptoms, and I did try a number of probiotics over the years.

Based on how I think probiotics work (increasing the work to be done by the innate immune system in the GI tract) I suspect that any palliative actions would come at the cost of healing elsewhere in the body. But I have no data, and the studies I have seen were all based on a flawed disease model, and therefore of no real help.

..Trevor..

1/24/08

I haven't stated a position on probiotics. There are many on the protocol who are convinced they are helpful, and I would prefer to concentrate on the key issues that folk really need to solve - No Vit D, plenty of Benicar, and a supportive family/medical environment. Probiotics are a second-order effect, I think (less important).

We now know that the GI tract relies on the innate (Th1) immune system, and the VDR, to deal with intestinal flora. A decade ago it was thought that antibodies (the Th2 system) was involved. So it is certain that ingesting probiotics will place a load on the very part of the immune system already weakened by fighting Th1 inflammation in the major organs. Whether this is good or bad is open to interpretation.

Every time I have personally started to take probiotics I have sensed a setback, rather than a surge forward. Last year I tried "Ultimate Flora - Critical Care - 50 Billion cultures per capsule" just to see what high-dose probiotics would do. I think I took one capsule, maybe two, before discarding the bottle in disgust.

I haven't seen any noticeable changes in intestinal function when I took lesser dose brands, nor did I sense any other benefits (but remember that I have no real GI immunopathology for the probiotics to palliate).

So I tend to leave it to the individual. Most Th1 patients have severe GI tract involvement, and dealing with that takes just about every tool in their arsenal. If Probiotics seem to help, then who am I to say no? On the other hand, they do not form part of the base protocol, as any benefit is not obvious to me.

..Trevor..

2/08 A new paper out today shows that probiotics increase Interferon-gamma. That means they create a Th1 reaction, an innate immune reaction.

Researchers report in the British Journal of Sports Medicine, "Probiotic treatment also doubled levels of interferon gamma, a substance secreted by T cells that plays a key role in fighting viral infections."

Interferon gamma (amongst other things) catalyzes the amount of 1,25-D being produced (via CYP27B1). This would imply that healthy people would react differently to probiotics than sick people. Indeed, it confirms that probiotics work on the innate immune system, the Th1 pathways.

I am getting closer to becoming convinced that the mode of action of probiotics is to overload the innate immune system , focus it away from the Th1 pathogens, so as to reduce the patients' symptoms. ..Trevor..

I would caution against any desire for "re-establishment of the normal flora." It is the gut Flavobacter (and other species) that are capable of producing capnine and fueling the Th1 disease process again. Do we really want that? My answer is a resounding NO. Stay away from probiotics. They only suppress proper operation of the innate immune system. As time goes by we will be able to gather data on whether any of them are ultimately beneficial. But now just think of gut flora as unwanted pathogens resulting from our dietary habits (meat-eating, etc).

..Trevor..

See also Pondering probiotics


Members' experiences

-I may note also that I stopped taking probiotics about a week ago and since then I have noticed my immune symptoms have been stronger, such runny nose, irritated throat, scratchy eyes and nose, weakness, sore muscles and especially nausea. ~Jimmy_jimjim



Foundation Staff
.


Joined: Sat Jul 10th, 2004
Location:
Posts: 17283
Status: Offline
Posted: Sun Sep 11th, 2005 02:03
Quote
Reply

(filelink)

PROBIOTICS

Lactobacillus acidophilus is a "friendly" strain of bacteria used to make yogurt and cheese. Although we are born without it, acidophilus soon establishes itself in our intestines and helps prevent intestinal infections. Acidophilus also flourishes in the vagina, where it protects women against yeast infections.

Acidophilus is one of several microbes known collectively as probiotics (literally, "pro life," indicating that they are bacteria and yeasts that help rather than harm). Others include the bacteria L. bulgaricus, L. reuteri, L. plantarum, L. casei, B. bifidus, S. salivarius, and S. thermophilus and the yeast Saccharomyces boulardii. Your digestive tract is like a rain forest ecosystem, with billions of bacteria and yeasts rather than trees, frogs, and leopards. Some of these internal inhabitants are more helpful to your body than others. Acidophilus and related probiotics not only help the digestive tract function, they also reduce the presence of less healthful organisms by competing with them for the limited space available. For this reason, use of probiotics can help prevent infectious diarrhea.

Antibiotics can disturb the balance of your "inner rain forest" by killing friendly bacteria. When this happens, harmful bacteria and yeasts can move in and flourish. This can lead to vaginal yeast infections. Conversely, it appears that the regular use of probiotics can help prevent vaginal infections and generally improve the health of the gastrointestinal system. Whenever you take antibiotics, you should probably take probiotics as well, and continue them for some time after you are done with the course of treatment.

Sources
Although we believe that they are helpful and perhaps even necessary for human health, we don't have a daily requirement for probiotic bacteria. They are living creatures, not chemicals, so they can sustain themselves in your body unless something comes along to damage them, such as antibiotics.

Cultured dairy products such as yogurt and kefir are good sources of acidophilus and other probiotic bacteria. Supplements are widely available in powder, liquid, capsule, or tablet form. Grocery stores and natural food stores both carry milk that contains live acidophilus.

Therapeutic Dosages
Dosages of acidophilus are expressed not in grams or milligrams, but in billions of organisms. A typical daily dose should supply about 3 to 5 billion live organisms. Other probiotic bacteria are used similarly. The typical dose of S. boulardii yeast is 500 mg twice daily (standardized to provide 3 x 1010 colony-forming units per gram), to be taken while traveling, or at the start of using antibiotics and continuing for a few days after antibiotics are stopped.

Because probiotics are not drugs, but rather living organisms that you are trying to transplant to your digestive tract, it is necessary to take the treatment regularly. Each time you do, you reinforce the beneficial bacterial colonies in your body, which may gradually push out harmful bacteria and yeasts growing there.

The downside of using a living organism is that probiotics may die on the shelf. In fact, a study reported in 1990 found that most acidophilus capsules on the market contained no living acidophilus.1 The container label should guarantee living acidophilus (or bulgaricus, and so on) at the time of purchase, not just at the time of manufacture. Another approach is to eat acidophilus-rich foods such as yogurt, where the bacteria are most likely still alive.

To treat or prevent vaginal infections, mix 2 tablespoons of yogurt or the contents of a couple of capsules of acidophilus with warm water and use as a douche.

Finally, in addition to increasing your intake of probiotics, you can take fructo-oligosaccharides, supplements that can promote thriving colonies of helpful bacteria in the digestive tract. (Fructo-oligosaccharides are carbohydrates found in fruit. Fructo means "fruit," and an oligosaccharide is a type of carbohydrate.) Taking this supplement is like putting manure in a garden; it is thought to foster a healthy environment for the bacteria you want to have inside you. The typical daily dose of fructo-oligosaccharides is between 2 and 8 g.

Therapeutic Uses
Evidence from many but not all trials suggests that acidophilus and other probiotics may be helpful for preventing traveler's diarrhea and diarrhea caused by antibiotics, chemotherapy, or radiation therapy, as well as preventing and treating infectious viral diarrhea; it may also help irritable bowel syndrome.2–28,109-111, 121-122
Probiotics may also be helpful for preventing or treating eczema,29,30 preventing vaginal yeast infections,31–36 treating ulcerative colitis,37-39 and improving immunity.40–43

The bacteria Helicobacter pylori is the main cause of ulcers in the stomach and duodenum. Antibiotics can kill H. pylori, but more than one must be used at once, and even then the bacteria is not necessarily eradicated. Probiotics may be helpful. Evidence suggests that various probiotics in the Lactobacillus family can inhibit the growth of H. pylori.112-115 While this effect does not appear to be strong enough for probiotic treatment to eradicate H. pylori on its own, preliminary trials, including one double-blind trial,123 suggest that probiotics may help standard antibiotic therapy work better, improving the rate of eradication and reducing side effects.112-113,116-120,123

Preliminary double-blind trials suggest that probiotics might help prevent heart disease by reducing cholesterol levels.44,45,46

Probiotic treatment has also been proposed as a treatment for canker sores and as a preventative measure against colon cancer, but there is no solid evidence that it is effective.

There is some evidence that probiotics can help reduce symptoms of milk allergies when added to milk.49

Finally, probiotics may be helpful in a controversial condition known as yeast hypersensitivity syndrome (also known as chronic candidiasis, chronic candida, systemic candidiasis, or just candida). As described by some alternative medicine practitioners, yeast hypersensitivity syndrome consists of a population explosion of the normally benign Candida yeast that live in the vagina and elsewhere in the body, coupled with a type of allergic sensitivity to it. Probiotic supplements are widely recommended for this condition because they establish large, healthy populations of friendly bacteria that compete with the Candida that is trying to take up residence.

A year-long open trial of 150 women found Lactobacillus probiotics ineffective for preventing urinary tract infections as compared to cranberry juice or no treatment.50

What Is the Scientific Evidence for Acidophilus and Other Probiotics?

Traveler's Diarrhea
According to several studies, it appears that regular use of acidophilus and other probiotics can help prevent "traveler's diarrhea" (an illness caused by eating contaminated food, usually in developing countries).51,52 One double-blind, placebo-controlled study followed 820 people traveling to southern Turkey, and found that use of a probiotic called Lactobacillus GG significantly protected against intestinal infection.53

Other studies using S. boulardii have found similar benefits,54,55,56 including a double-blind, placebo-controlled trial enrolling 3,000 Austrian travelers.57 The greatest benefits were seen in travelers who visited North Africa and Turkey. The researchers noted the benefit depended on consistent use of the product, and a dosage of 1,000 mg daily was more effective than 250 mg daily.

Infectious Diarrhea
Probiotics may also help prevent or treat acute infectious diarrhea in children and adults.

A review of the literature published in 2001 found 13 double-blind, placebo-controlled trials on the use of probiotics for acute infectious diarrhea in infants and children; 10 of these trials involved treatment, and 3 involved prevention.109 Overall, the evidence suggests that probiotics can significantly reduce the duration of diarrhea and perhaps help prevent it. The evidence is strongest for the probiotic Lactobacillus GG, and for infection and with a particular virus called rotavirus.
For example, one double-blind, placebo-controlled trial of 269 children (age 1 month to 3 years) with acute diarrhea found that those treated with Lactobacillus GG recovered more quickly than those given placebo.58 The best results were seen among children with rotavirus infection (rotavirus is a virus that can cause severe diarrhea in children). Similar results with Lactobacillus GG were seen in a double-blind study of 71 children.59

In addition, a double-blind study evaluated the possible benefits of the probiotic L. reuteri in 66 children with rotavirus diarrhea.60 The study found that treatment shortened the duration of symptoms, and the higher the dose, the better the effect.

A double-blind, placebo-controlled study of 81 hospitalized children found that treatment with Lactobacillus GG reduced the risk of developing diarrhea, particularly rotavirus infection.61 A double-blind, placebo-controlled study found that Lactobacillus GG helped prevent diarrhea in 204 undernourished children.62

Other studies indicate that the probiotics B. bifidum, Streptococcus thermophilus,L. casei, Lactobacillus LB, and S. boulardii - both individually and combined with L. reuteri and L. chamnosus - may also help prevent or treat diarrhea in infants and children.63–68, 121-122 One study found that bacteria in the B. bifidum family can kill numerous bacteria that cause diarrhea.69
Keep in mind that diarrhea in young children can be serious. If it persists for more than a day, you should take your child to a physician.

A large (211 participant) double-blind, placebo controlled study found that adults can benefit from probiotic treatment as well.26

Antibiotic-Related Diarrhea
The results of many but not all double-blind and open trials suggest that probiotics, including S. boulardii and Lactobacillus GG, may help prevent or reduce antibiotic-related diarrhea.70–79 One study evaluated 180 people, who received either placebo or 1,000 mg of saccharomyces daily along with their antibiotic treatment, and found that the treated group developed diarrhea significantly less often.80 A similar study of 193 people also found benefit.81 However, a study of 302 people found no benefit with Lactobacillus GG.82

Other Forms of Diarrhea
Preliminary evidence suggests that probiotics may be helpful for reducing diarrheas and other gastrointestinal side effects caused by cancer treatment (radiation or chemotherapy).83,84

Small double-blind studies suggest S. boulardii might be helpful for treating chronic diarrhea in people with HIV, hospitalized patients being tube-fed, and people with Crohn's disease.85–88

Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)
The conditions Crohn’s disease and ulcerative colitis fall into the family of conditions known as Inflammatory Bowel Disease. Chronic diarrhea is a common feature of these conditions.

A double-blind trial of 116 people with ulcerative colitis compared probiotic treatment against a relatively low dose of the standard drug mesalazine.89 The results suggest that probiotic treatment might be equally effective as low-dose mesalazine for controlling symptoms and maintaining remission. Evidence of benefit was seen in other trials as well.90

Another study found S. boulardii helpful for the diarrhea of Crohn’s disease.87

Probiotics might be useful for people with ulcerative colitis who have had part or all of the colon removed. Such people frequently develop a complication called "pouchitis," inflammation of part of the remaining intestine. A 9-month double-blind trial of 40 people found that a combination of three probiotic bacteria could significantly reduce the risk of a pouchitis flare-up.91 Participants were given either placebo or a mixture of various probiotics, including four strains of Lactobacilli, three strains of Bifidobacteria, and one strain of Streptococcus salivarius. The results showed that treated people were far less likely to have relapses of pouchitis.

Irritable Bowel Syndrome
People with irritable bowel syndrome (IBS) experience crampy digestive pain as well as alternating diarrhea and constipation and other symptoms. Although the cause of irritable bowel syndrome is not known, one possibility is a disturbance in healthy intestinal bacteria. Based on this theory, probiotics have been tried as a treatment for IBS.
In a 4-week, double-blind, placebo-controlled trial of 60 people with IBS, treatment with L. plantarum reduced intestinal gas significantly.92 The benefits persisted for an additional year after treatment was stopped.

In another 4-week, double-blind trial, 40 people with IBS again received either L. plantarum or placebo.110 The results showed improved overall symptoms in the treated group as compared to the placebo group.

A small 6 week trial using L. acidophilus also found indications of benefit.93 However, in a double-blind, placebo-controlled crossover study of 24 people with irritable bowel syndrome, use of Lactobacillus GG failed to produce any noticeable benefit.111

Eczema
Use of probiotics during pregnancy and after childbirth may reduce risk of childhood eczema. In a double-blind, placebo-controlled trial that enrolled 159 women, participants received either placebo or Lactobacillus GG capsules beginning 2 to 4 weeks before expected delivery.94
After delivery, breast-feeding mothers continued to take placebo or the probiotic for 6 months; formula-fed infants were given placebo or probiotic directly for the same period of time. The results showed that use of Lactobacillus GG reduced children's risk of developing eczema by approximately 50%.

According to two-double blind trials, infants who already have eczema may benefit from probiotics as well.95,96

Vaginal Yeast Infections
A review of the many studies on the use of oral and topical acidophilus to prevent vaginal yeast infections concluded that it may be effective, but more study is needed.97,98

Immunity
A number of studies suggest that various probiotics can enhance immune function; however, most of them were not double-blind.99 One 12-week, double-blind, placebo-controlled trial evaluated 25 healthy elderly people, half of whom were given milk containing a particular strain of Bifidobacterium lactis, the others milk alone.100 The results showed various changes in immune parameters which the researchers took as possibly indicating improved immune function. Another double-blind, placebo-controlled study of 50 people using B. lactis had similar results.101

In addition, a 7-month, double-blind, placebo-controlled study of 571 children in day-care centers in Finland found that use of milk fortified with Lactobacillus GG reduced the number and severity of respiratory infections.102

Cholesterol
An 8-week, double-blind, placebo-controlled trial of 70 overweight people found that a probiotic treatment containing S. thermophilus and Enterococcus faecium could reduce LDL ("bad") cholesterol by about 8%.103 Similarly positive results were seen in other trials of the same or other probiotics.104–107 However, a 6-month double-blind, placebo-controlled trial found no long-term benefit.108 Researchers speculate that participants stopped using the product regularly toward the later parts of the study.

Safety Issues
There are no known safety problems with the use of acidophilus or other probiotics. Occasionally, some people notice a temporary increase in digestive gas.

Interactions You Should Know About
If you are taking antibiotics, it may be beneficial to take probiotic supplements at the same time, and to continue them for a couple of weeks after you have finished the course of drug treatment. This will help restore the balance of natural bacteria in your digestive tract.

Last reviewed January 2003 by HealthGate CAM Medical Review Board
All HealthGate health and medical information found on this site is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits.

What They Are:
Probiotic supplements contain helpful bacteria that assist in balancing the levels of indigenous microorganisms in the human body. Probiotics are available in varied forms such as yogurt and other foods, capsules, tablets, beverages, and powders. Probiotics should not be confused with prebiotics, which are complex sugars (such as inulin and other fructo-oligosaccharides) that are ingested as fuel for bacteria already present in the gastrointestinal tract; although prebiotics and probiotics are sometimes combined in the same product and termed synbiotics.

What They Do:
The normal human gastrointestinal tract contains hundreds of different species of harmless bacteria, referred to as intestinal flora. When the normal balance of these bacteria is disturbed by illness or antibiotic treatment, the most common effect is diarrhea. Probiotics work by colonizing the small intestine and crowding out disease-causing bacteria, thereby restoring balance to the intestinal flora. They may also produce substances that inhibit pathogenic bacteria, compete for nutrients with them, and stimulate the body's own immune system.

Antibiotics often lower the numbers of beneficial bacteria in the body along with their intended targets, and probiotics can replace these beneficial bacteria and lessen some negative side effects of antibiotics. Saccharomyces boulardii, Enterococcus faecium and Lactobacillus have been clinically proven to prevent antibiotic-caused diarrhea. Successful clinical trials have also been conducted using Lactobacillus to treat H. pylori infection and Lactobacillus plantarum to treat irritable bowel syndrome. Lactobacillus GG (a strain of L. rhamnosus) and Lactobacillus reuteri have been shown to reduce the duration of diarrhea due to certain infections in infants and young children.

Studies using probiotics (Lactobacillus, Bifidobacterium, Streptococcus, and Saccharomyces species) to treat traveler's diarrhea, however, have not shown definitive results. Although the evidence isn't clear-cut, probiotics have been studied as a treatment for many other conditions and their side effects; including, lactose intolerance, respiratory and GI problems resulting from cystic fibrosis, Crohn's disease, cancer prevention, high blood cholesterol, tuberculosis, eczema, canker sores, milk allergies, vaginal and urinary tract infections, and prevention of respiratory infections in children.

See ConsumerTips™: What to Consider When Using for dosage information and, for more information, see the Probiotics article in the Natural Product Encyclopedia on this Web site.

Quality Concerns and What CL Tested For:
Neither the FDA nor any other federal or state agency routinely tests probiotics for quality prior to sale. However, quality issues for probiotic supplements can include the following:
· The viability of bacteria in the product — how many organisms are alive when the consumer purchases it? Some products make no claim at all and others only claim the amount at the time of manufacture.
· The types of bacteria in the product — the product should contain the bacterial species that it claims on the label, and potentially pathogenic microorganisms should not be present.
· Enteric protection of the product — Some types of bacteria can't survive as they pass through stomach acid and into the small intestine where the bacteria would attach and grow (see ConsumerTips™: What to Consider When Buying for more information). Ideally the product should contain bacteria that research shows can survive passage through the stomach or it should be enteric coated. Products in tablets should also be able to properly disintegrate so as to release the probiotic bacteria and not pass through the body intact.
ConsumerLab.com, as part of its mission to independently evaluate products that affect health, wellness, and nutrition, purchased many leading probiotic products sold in the U.S. and tested them to determine whether 1) they possessed the claimed amount of viable bacteria or, if not listed on the label, at least 1 billion live organisms per maximum suggested daily serving, 2) they were free of contamination with yeast, mold, and types of bacteria with disease-causing potential, and 3) tablets disintegrated properly so that their contents would be released, or if enteric-coated, their contents would be released after passing through the stomach. (See Testing Methods and Passing Score for more information).

What CL Found:
ConsumerLab.com purchased 25 probiotic products: 19 were for use by the general population, 3 were specifically marketed for use by children, and 3 were yogurts. Among these, eight products claimed from 1 billion to 6 billion live organisms per daily serving. Thirteen other products claimed specific numbers of live organisms (some as high as 60 billion) but only as of the time of manufacture — not indicating the number that would be in the product at the time of use. The yogurts and one supplement did not specify bacterial counts (see How Products were Selected and What to Consider When Buying for more information).

On testing, ConsumerLab.com found that 8 of the products contained less than 1% of the claimed number of live bacteria or of the expected minimum of 1 billion. In fact, six products had only a few thousand live bacteria — one-ten thousandth of the amount claimed or expected. Interestingly, products that did not claim a specific number of live bacteria at the time of use were much more likely to have been low, while 7 of the 8 products that gave expected numbers at the time of use (not limited to the time of manufacture) met these counts. It is quite likely that products that were low in bacteria may not work. Some clinical studies have shown that products with even tens of millions of live bacteria may be ineffective, as opposed to those having one billion or more live bacteria.

None of the products were contaminated with pathogenic bacteria, mold, or fungus. All tablet products disintegrated properly so that their bacteria would be released in the body. The one enteric-coated capsule passed special testing that confirmed its ability to pass through the stomach and deliver its bacteria to the intestine. See Testing Methods and Passing Score for more information about the testing and criteria.

Products That Passed Testing:

Listed alphabetically below by name the products that passed ConsumerLab.com's independent testing of Probiotic Supplements and Foods. Also shown are the claimed types and numbers of live bacteria per suggested daily serving (or the minimum expected number if not claimed).

CONSUMERLAB.COM APPROVED QUALITY PROBIOTIC PRODUCTSClick on for additional information on the productTo find retailers that sell some of the listed products click here.
Product Name(Pill Type or Form) Manufacturer/Distributor Number of ProbioticBacteria in Maximum SuggestedDaily Serving* (Billions of Cells) Types of Organisms Claimed
Supplements for General Population Use:
Country Life® Hypoallergenic, Milk-Free Power-Dophilus™ Dietary Supplement (vegetarian capsule) Dist. by Country Life® 1 (E) Lactobacillus rhamnosus, Lactobacillus acidophilus,Bifidobacterium lactis (bifidum),Bifidobacterium longum
Enzymatic Therapy Natural Medicines® Acidophilus Pearls™ with Patented True Delivery™ Technology (enteric-coated "pearl" capsule) Dist. by Enzymatic Therapy, Inc. 1 (C) Lactobacillus acidophilus and Bifidobacterium longum
Flora Source™ Super Potency Probiotic Cultures (vegetarian capsule) Dist. by MBA Company 1 (E) Lactobacillus rhamnosus, Bifidobacterium bifidum, Lactobacillus acidophilus, Bifidobacterium infantis, Bifidobacterium longum, Streptococcus thermophilus, Lactobacillus plantarum, Lactobacillus salivarius, Lactobacillus casei, Lactobacillus bulgaricus, Lactobacillus acidophilus DDS-1, Lactobacillus sporogenes, Lactobacillus lactis, Lactobacillus paracasei, Bifidobacterium lactis, Lactobacillus brevis
Nature Made®, Recommended By Pharmacists, Acidophilus Dietary Supplement, 500 Million Live Cells Per Tablet Dist. by Nature Made Nutritional Products 1 (C) L. acidophilus
Nutrilite® IntestiFlora Dietary Supplement (powder) Dist. by Access Business Group International LLC 1 (C) Bifidobacterium longum, Lactobacillus acidophilus
Puritan's Pride® Inspired By Nature™ Milk Free Acidophilus, 2.4 Billion Live Cells Per Capsule, 50% More Live Cells (vegetarian capsule) Mfd. by Puritan's Pride®, Inc. 1 (E) Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Lactobacillus Bifidum
Puritan's Pride® Inspired By Nature™ Potent Acidophilus Supplement with Pectin (capsule) Mfd. by Puritan's Pride®, Inc. 1 (E) Lactobacillus acidophilus, L. brevis, L. salivarius, L. helveticus, L. bulgaricus, Bifidobacterium bifidum
The Premier Probiotic Culturelle™ with Lactobacillus GG, Patented Maximum Potency (capsule) Dist. by CAG Functional Foods 20 (C) Lactobacillus GG
Trader Darwin's™ For the Survival of the Fittest LiveBac® Acidophilus, 1 Billion Organisms per Caplet at Time of Manufacture (caplet) Dist. by Trader Joe's 1 (E) Lactobacillus acidophilus, Lactobacillus bulgaricus, Bifidobacterium bifidum, Streptococcus thermophilus
Vital Life Vital-Immune Biotic Probiotic Supplement, Complete Non-Dairy Combination of Microorganisms (vegetarian capsule) Dist. by Klaire Laboratories, Inc. 6 (C) Lactobacillus rhamnosus, Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum
Vitamin World® Naturally Inspired™ Milk Free Acidophilus, 2.4 Billion Live Cells Per Capsule, 50% More Live Cells (vegetarian capsule) Mfd. by Vitamin World®, Inc. 1 (E) Lactobacillus Acidophilus, Lactobacillus Rhamnosus, Lactobacillus Bifidum

Supplements for Use by Children:
GNC Natural Brand™ Children's Chewable Acidophilus, Grape Flavor (tablet) Dist. by General Nutrition Corporation 1 (C) L. acidophilus
Nature's Way® Once Daily Powdered Primadophilus® for Children (powder) Dist. by Nature's Way Products, Inc. 1.5 (C) Lactobacillus rhamnosus, Bifidobacterium infantis, Bifidobacterium longum, Lactobacillus acidophilus
UAS Labs DDS® Junior, Bifidus, Acidophilus, FOS, 2 Billion CFU/g, Non Dairy Powder Dist. by UAS Laboratories 1 (E) B. infantis & L. acidophilus

Yogurts:**
Breyers® 99% Fat Free Fruit on the Bottom Lowfat Yogurt, 1% Milkfat, Black Cherry Dist. by Kraft Foods North America, Inc. 1 (E) Made with active yogurt cultures with L. acidophilus
Colombo® Classic Lowfat Yogurt, 1% Milkfat, Vanilla Dist. by Colombo®, Inc, 1 (E) Made with active yogurt cultures including L. acidophilus.
Stonyfield Farm® French Vanilla Nonfat Yogurt Dist. by Stonyfield Farm® Yogurt 1 (E) S. thermophilus, L. bulgaricus, L. acidophilus, Bifidus, L. casei, and L. reuteri
* (C) = Claimed at Time of Use; (E) = Expected Minimum if Not Claimed
** Results for yogurts based on an 8-ounce (1 cup) serving.
Unless otherwise noted, information about the products listed above is based on the samples purchased by ConsumerLab.com for this Product Review. Manufacturers may change product ingredients and information at any time, so be sure to check labels carefully when evaluating the products you use or buy. If a product's ingredients differ from what is listed above, it may not necessarily be of the same quality as what was tested. It also cannot be assumed that other products from a Manufacturer or Distributor listed above are of equal quality to those listed.

ConsumerTips™: What to Consider When Buying:
When probiotic supplements are properly labeled, it is easy to determine what types of bacteria are present. Bacterial organism's names should be listed in italics, with the genus name capitalized and listed first. The genus name may also be abbreviated with its first letter (e.g., Lactobacillus acidophilus or L. acidophilus). The species most commonly seen in probiotics and that have been tested in laboratory and clinical studies are Lactobacillus acidophilus, L. bulgaricus, L. casei, L. gasseri, L. plantarum, Bifidobacterium bifidum, B. lactis, B. longum, Enterococcus faecium, and Saccharomyces boulardii (a yeast). Other species that can be used as probiotics but have less accompanying research are L. johnsonii, L. reuteri, L. rhamnosus, B. breve, B. infantis, E. faecalis, and Streptococcus salivarius. Some probiotic bacterial strains have been patented and are accompanied by substantial research into their effects. L. casei GG (a strain of Lactobacillus rhamnosus found in Culturelle capsules), L. casei in Actimel (Dannon), and LC1 (Nestle) are three examples. Some research has shown that it may be more effective to take a probiotic supplement that contains a mixture of bacterial strains rather than a single bacterial species.

While many products make claims regarding the number of organisms in the product, these typically refer to the numbers at the time manufacture — which can be very different from the amount still viable at the time of purchase. Exposure to heat, moisture, and oxygen can all negatively affect survival of probiotics in a product, so the expiration date is especially important to consider when buying products. Some products have an enteric coating, because certain probiotic bacteria need protection in order to survive exposure to gastric fluid. In general, Lactobacillus, Bifidobacterium, and Streptococcus species do not need enteric coating as they can survive passage through the stomach. However, L. bulgaricus and S. thermophilus, as well as Leuconostoc and Lactococcus species, cannot survive passage through the stomach. These bacteria are commonly found in yogurt because they are used as starters for dairy products. However, they do not colonize the intestinal tract; so they are likely to have little effect as probiotics. Some bacteria naturally sporulate ("hibernate" within a protective coating) when they are exposed to harsh conditions, and some researchers postulate that sporulated bacteria are more resistant to the harsh conditions found in the intestinal tract. Consequently, another delivery method is to manufacture probiotics in the form of bacterial spores — this is most often used for bacteria of the genus Bacillus.

What to Consider When Using:
The recommended daily intake for probiotic supplements is 1 billion units (sometimes referred to as colony forming units, or CFU's) to 10 billion units per day. These amounts may be written on the label as 1 x 109 or 109 for one billion units, and 1 x 1010 or 1010 for ten billion units.

For the treatment of diarrhea, it is recommended to start taking probiotic supplements as soon as symptoms appear. However, if symptoms persist for several days, see a physician. Following antibiotic treatment, take probiotic supplements for 2 weeks. Probiotics are sometimes taken before travel in an attempt to prevent traveler's diarrhea. To gain probiotic benefits from yogurt or other dairy foods, look for products labeled "contains live cultures" or "active cultures". Some yogurts may also state the species of bacteria they contain.

For treating vaginal bacterial infections, vaginal suppositories containing approximately 1 billion Lactobacillus organisms are typically used.

If you are taking antibiotics, it may be advisable to take them at least 2 hours apart from taking a probiotic, as the antibiotic could potentially kill the organisms.

Although not always a requirement, it is advisable to keep probiotic products refrigerated to prolong their shelf life. Interestingly, all of the products that specifically suggested that they be kept refrigerated passed this review — possibly because they were maintained under more favorable conditions during their storage and distribution.

Concerns and Cautions:
There are no known safety issues with probiotic bacteria, but occasionally, some people notice a temporary increase in digestive gas.

In a few cases among severely ill or immunocompromised individuals, probiotic use has caused bacteremia (presence of bacteria in the blood) or pathological infections resulting in severe illness. However, when taken at appropriate doses in healthy people, they are very safe. Even HIV-positive adults have taken probiotics for up to 3 weeks without side effects.

To further assist consumers, ConsumerLab.com is licensing its flask-shaped CL Seal of Approved Quality (see The CL Seal) to manufacturers for use on labels of products that have passed its testing. ConsumerLab.com will periodically re-evaluate these products to ensure their compliance with ConsumerLab.com's standards.

Consumers should inform their healthcare providers of the dietary supplements they take.


For probiotics, the key for me is to get it in enteric coated capsules. I can quickly tell the difference in my digestion. The normal capsules and powders never helped me like the enteric coated capsule type. Solaray Multidophilus 12 has been the best brand for me. slowmo

=====================================

The brand name is NOW, it is Acidophilus Two Billion Highest Quality 100 capsules. It has no additivies. It cost $6.99 plus tax. I have had no bloating or cramping and it has helped me get along with the antibiotics of MP, both of them. I am in Phase 2. Barney


========================================

I have also had terrible bloating caused by some probiotics. I've tried different brands, and the one that doesn't bother me is Nature's Day Once Daily Primadophilus and Bifidus, enteric coated. It's in the fridge at the health food store. It costs $17.99 for 90 caps. Expensive but it's been helpful, and without causing trouble.

=======================================

I have found Culterelle and Bifa-15 to be excellent probiotics. Lonestartick

=========================================

There is one on the market made by Genestra called HMF forte. It stands for human microflora and according to my doctor it is superior to any probiotic on the market. All of the other probiotics come from animal sources.
Lisa66

============================================

In Australia we have a product available from Blackmore's brand called FORBIOTIC. They claim that this strain of probiotic bacteria has been specifically bred to be antibiotic resistant. Clever, yes?

I don't know if a similar product is available overseas, but I can tell you that the Blackmore's brand is one of the "Best" & most trusted brands. Also, I have tried it out in yoghurt-making - and it set up the milk very well, so there must be plenty of live culture in it. Claudia

=============================================

There is another type of probiotic that I wonder if you have tried. I heard about it from a very respected doctor, who mentioned it at a conference (CIIN). From what he said, t's a soil based organism that was developed into a probiotic because it produced a substance that killed Candida quite effectively.

When I took it, I had a Candida die-off reactions that was just as strong as what I had on Diflucan. I have not used it extensively, since I become sensitive to just about everything and became sensitive to this product too (and my Candida problem lessened), but I thought you might consider it worth looking into. The SBO (soil based organism) product I used is the most hypoallergenic one I found (and was the one recommended by the doctor mentioned above) and it is called Flora-Balance. You can find out more by doing a Internet search (the company I order from generally is http://needs.com ). It could be used in a douche as well.